Early identification prevents catastrophic consequences.
MR. ROBERT TRENT*, a 22-year-old man, arrives at the ED with acute, uncontrolled severe back pain, which he rates as 10 (the worst possible). The pain, which began 5 hours earlier, was unrelieved with ibuprofen. Robin, the nurse, takes his vital signs: temperature 98.7° F, HR 110 bpm, RR 25 breaths per minute, BP 145/80 mmHg, and SpO2 99% on room air. She notes that Mr. Trent appears oriented to person, place, time, and situation.
Mr. Trent reports an episode of urinary incontinence, saying that he didn’t feel a sense of urination. Recognizing the symptoms of cauda equina syndrome (CES) or spinal cord compression (SCC), Robin notifies the rapid response team.
History and assessment
A rapid assessment includes respiratory status, sensation, numbness, range of motion, sexual function, and bowel and bladder control. Mr. Trent reports numbness, burning, and tingling in the groin, buttocks, genitals, and upper inner thighs. He says that he isn’t sexually active.
While conducting a physical examination, Robin notices that Mr. Trent’s legs are weaker than his arms. He has decreased muscle tone and diminished deep tendon reflexes.
Taking action
After reporting her suspicion of spinal cord involvement to the ED physician, Robin arranges a neurosurgical consultation and a STAT MRI. The neurosurgeon assesses Mr. Trent’s range of motion to sit, stand, walk, bend, lie down, and lift his legs; these maneuvers indicate stability, sensation, strength, reflexes, alignment, and motion.
Robin prioritizes the MRI to identify spinal cord compression and inform urgent treatment to avoid paralysis, organ dysfunction, and death.
If needed, other imaging, such as X-rays, computed tomography scans, and myelograms, also can provide enhanced views of bones, nerve roots, spinal cord, displaced spinal cord or nerves due to herniated disks, bone spurs, and tumors.
Diagnosis and treatment
The MRI indicates CES, which requires immediate lumbar laminectomy. Robin administers corticosteroids, as ordered, to reduce edema. Treatment goals include pain relief, function restoration, pressure relief from the cauda equina and spinal cord area, and prevention of irreversible neurological deficits.
The procedure restores Mr. Trent’s function. After 2 days in the hospital, he returns home with a follow-up appointment and resources, including a 24-hour hospital triage number.
Education and follow up
SCC can prove life-threatening in the event of compression of the upper spinal cord; risks increase when the condition becomes symptomatic. CES can cause permanent disability. MRI to determine compression location aids treatment decisions.
Teaching patients about CES and SCC red flag symptoms (respiratory distress, loss of sensation, severe pain, sexual dysfunction, loss of bowel or bladder control) and when to go to the ED helps promote better outcomes. Use the teach-back method to ensure the patient understands your instructions to avoid paralysis or death.
*Names are fictitious.
The authors work at City of Hope National Medical Center in Duarte, California. Stephanie Magallanes is a nurse, and Jeannine M. Brant is executive director of clinical science and innovation.
American Nurse Journal. 2026; 21(4). Doi: 10.51256/ANJ042652
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